Daytime Enuresis and Incentives

Updated on April 12, 2013
B.W. asks from Seattle, WA
8 answers

Long story short: my 5 year old son, who is typically developing and is in Kindergarten, has had many pee accidents this year. He potty trained at 3 but has always been a little "leaky" especially when constipated. In preschool he never had accidents, in Kinder they don't really remind him. His accidents often go unnoticed because they aren't "big" but of course if the teachers notice they will help him change. He won't tell them he is wet. I took him to the ped a few months ago and she said since he is always dry at night it is probably not physiological. She said make sure you give him Miralax every day since it seems to be related to constipation. Of course that can sometimes make for some messy poops, and he isn't the greatest wiper, so I don't want that to be a problem at school either! He LOVES his Wii Mario Cart and now we are thinking he should have to "earn" Mario Kart by staying dry. But is that too harsh and too close to "punishment" since it may be seen as taking a privilege away rather than earning it? Open to suggestions, especially if you have been through enuresis with your kid. EDITED: I should add-he gets very annoyed when we remind him to go potty. I doubt he gets as annoyed with the teachers, but chances are they are so busy (full day K) that it hard to both for him to remember to go and for them to remember to remind him. I'm not sure he DOESN'T have ANY control over it though, because it doesn't happen all the time, just sometimes. The poop may be pushing down on his bladder (that is why constipation can cause enuresis) but he says he still feels the urge to go. He will be literally dancing around and we will remind him and he gets annoyed and whines "I don't have to!" Good idea about possible being afraid of the potty at school-I will ask him about that.

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M.S.

answers from Portland on

Does he have any control over it? It seems like it is not really something he can control. If he can't, then why should he have to earn something by doing something he can't control? He might stay dry at night because he is lying down and has already gone poop. So, NO I don't think this sounds fair or like a good idea. Instead, I would try some probiotics and maybe a watch with an alarm to teach him to go since he isn't feeling the need or it is leaking out.

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M.J.

answers from Milwaukee on

I think it's the job of the teachers to try and meet their children's needs - whatever they are. Your child needs to be reminded to use the restroom. Because his needs are not behavioral outbursts he is easily forgot. They need to make sure they remind him to use the potty a few times per day. My almost 4 year old started to have tons of pee accidents everyday. His teachers noticed and now remind him many times to go and it's really helped. Get his teachers on board.

At home make sure you never say "do you have to go potty?" That answer will always be no. Say "hey it's potty time - go fast to try and see how fast you can get the pee out". Put cheerios in the potty as target practice - anything to make it fun. My son just gets so wrapped up in what he is doing that he does not want to stop to go potty, thus it leaks out a little cuz he is holding it so long.

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O.O.

answers from Kansas City on

I have not, but can you ask the Kindergarten teachers to give him an extra bathroom trip or two?

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K.M.

answers from Chicago on

My child has no urinary issues and dances around and says "I don't have to pee!!!" We just make him go even if he gets frustrated.

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G.B.

answers from Oklahoma City on

I have a lot of years in child care with school aged kids. Kindergarteners almost across the board start having accidents even if they've never had them since they were potty trained. It's a developmental thing plus they have a large growth spurt around then. They go from looking like a pre-schooler to an elementary school aged kid. It's a normal natural stage they go through.

Just let it go. PLUS the doc told you he's constipated. If you're not going to treat one of the causes of it then he shouldn't have to earn anything or lose anything because he didn't get the medication the doc said he needed.

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A.C.

answers from Salt Lake City on

My son went through this for several years to the point where he was daytime wetting 3-6 times a day but it was also coupled with nighttime wetting. We did visit the pediatric urologist, which I would suggest if you are not able to get a handle on it over the next 6 months. I mention this just because our pediatrician, as much as we liked him, obviously had no knowledge about these issues- the suggestions and prescriptions he gave us only made things worse and the pediatric urology office deals with stuff like this all day long and helped so much.
Anyway, at age 6, they recommended a "pee schedule". We had a chart and we made sure that he sat in the toilet every 2 hours no matter what. It was very much like re-potty training. Each time that he sat on the toilet, we marked it off on the chart. They recommended an incentive for each day that he used the toilet at least every 2 hours- NOT an incentive for "not wetting pants". The stated at his age, the incentive should be something immediate (a candy, video game time at end of night, extra bedtime story, whatever his "currency" is- if Mario Cart is his currency, by all means use it! My son loves his video games too so I use it to my advantage and get much better results when behavior is tied to something he loves.) Incentives that will not work as well are long-term incentives (ie follow schedule for a week and we will go out for ice cream). The point of the retraining is not only to prevent accidents, but to also remind child that they NEED to use bathroom often (their minds are going so many different ways, they often forget or do not realize it is a priority), also one of the things that happens (hopefully I explain this right!) is if a person "holds their urine" by not going to the bathroom in a timely manner, after a while of doing this the bladder muscles will build up and become stronger from holding it. This can make it harder to sense that the bladder is full and also the muscles become so strong that accidents are pretty much unavoidable. So the retraining will help diminish those muscles over time.
When we followed the schedule, we had results very quickly. However you need to stick with the schedule for at least a year even if it seems like things are better.
It was strange, the schedule helped a ton, but we did waiver and would get lazy about the schedule and things would go back. However, once we moved (a big, anticipated move), that was the end. My son immediately stopped daytime wetting. I have to wonder if a lot if the problem was stress.
In regard to him being annoyed, I would just be matter of fact and say, "tough, get used to it, this is what will be happening for the next year!" also we bought my son a watch with a timer and had his teacher on board with him being excused every 2 hours. The timer was a distraction so I obtained a classroom schedule from the teacher and had my son memorize when to go to bathroom each day (ie before bus comes, right after Reading time at 9, at lunch recess, right after Math, right when gets home). Good luck and please let me know if you have any questions.

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G.D.

answers from Detroit on

My 1st grader OFTEN has to go very bad after school. If we have to go to a store after school she is running for the bathroom. I've asked her and she has expressed a great fear of the toilet at school. Once or twice she has claimed there are no lights in the bathroom. I know this isn't true.
Do you think, perhaps, that he is having the issues due to unfamiliar territory?

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M.P.

answers from Portland on

It's been my experience that in K the teacher or aide takes all the children to the bathroom on a regular schedule. Is he not going then? I'd talk with the teacher to find out what happens in her room. If he's not taking advantage of these times, ask the teacher how she can handle it in her classroom. Does she insist that he go? I'm sure he's not the first one to have difficulty.

Instead of giving him a consequence for having an accident give him a consequence for not going to the bathroom when you tell him to do so. He should not have an option of going to the bathroom or not. He must go and there will be a consequence if he doesn't at least try to pee or have a bowel movement.

My grandson had a lot of difficulty with constipation at that age. He also took Miralax. I suggest that Miralax will not give him a runny movement. I wonder if he doesn't have a medical issue such as irritable bowel syndrome. Or perhaps he's allergic to a food or has a lactose intolerance. Ask the doctor about that.

Keep a record of what he's eaten and of his activity prior to having a loose bowel movement and see if there's a pattern. Note every bowel movement, and its consistency. Food and emotions can affect movements. See if there is a pattern.

I would not make staying dry a way to earn anything that he already has the ability to do. Perhaps reward him for staying dry by giving him something extra. Keep a chart and after a week of being dry take him for an ice cream, for example.

Talk with him about ways in which he can help himself stay dry. Talk about how his body works. Tell him you're going to help him build a routine so that he can stay dry.

As for bowel movements, have you tried having him sit on the toilet 30 minutes after his evening meal. Or, if you have time, after breakfast. Make this a daily routine. Take him by the hand and lead him to the bathroom. Make it fun. Perhaps have toys in the bathroom with which he can only play while sitting on the toilet. Read to him. Tell stories. Start a story, have him add something, you add something, he adds something. Sing.

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